Novel Colorimetric and Light Scatter Methods to Identify and Manage Peritoneal Dialysis-Associated Peritonitis at the Point-of-Care

Stephnie M. Kennedy, Darren Kell, Duncan Henderson, Ana Yepes Garcia, Adam S. Milner, Tom Willett, Ryan Griffiths, Peter Foster, William Kilgallon, Rachel Cant, Christopher G. Knight, Richard Corbett, Habib Akbani, Graham Woodrow, Bhrigu Sood, Osasuyi Iyasere, Simon Davies, Junaid Qazi, Anand Vardhan, Laura GillisMartin Wilkie, Curtis B. Dobson

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Peritoneal dialysis (PD)-related peritonitis (PDRP) is a common cause of transfer to hemodialysis, patient morbidity, and is a risk factor for mortality. Associated patient anxiety can deter selection of PD for renal replacement therapy. Diagnosis relies on hospital laboratory tests; however, this might be achieved earlier if such information was available at the point-of-care (POC), thereby significantly improving outcomes. The presence of culturable microbes and the concentration of leukocytes in effluent both aid peritonitis diagnosis, as specified in the International Society for Peritoneal Dialysis (ISPD) diagnostic guidelines. Here, we report the development of 2 new methods providing such information in simple POC tests. Methods: One approach uses a tetrazolium-based chemical reporting system, primarily focused on detecting bacterial contamination and associated vancomycin-sensitivity. The second approach uses a novel forward light-scatter device (QuickCheck) to provide an instant quantitative cell count directly from PD patient effluent. Results: The tetrazolium approach detected and correctly distinguished laboratory isolates, taking 10 hours to provide non-quantitative results. We compared the technical performance of the light scatter leukocyte counting approach with spectrophotometry, hemocytometer counting and flow cytometry (Sysmex) using patient effluent samples. QuickCheck had high accuracy (94%) and was the most precise (coefficient of variation <4%), showing minimal bias, overall performing similarly to flow cytometry. Conclusion: These complementary new approaches provide a simple means to obtain information to assist diagnosis at the POC. The first provides antibiotic sensitivity following 10 hours incubation, whereas the second optical approach (QuickCheck), provides instant accurate total leukocyte count.

Original languageEnglish
Pages (from-to)589-600
Number of pages12
JournalKidney International Reports
Volume9
Issue number3
Early online date30 Dec 2023
DOIs
Publication statusPublished - 1 Mar 2024

Keywords

  • diagnosis
  • leukocyte
  • peritoneal dialysis
  • peritonitis

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